ACGME espionage

January 24, 2008

i went to this ACGME (governing body of graduate medical education) dinner last night with a group of residents from various specialties and a couple of ACGME bigwigs from harvard who are traveling around looking at the way residents are treated in various institutions. it was like a united nations of residents — an ortho chief here, a psychiatrist there, and of course a smattering of medicine and pediatrics residents. i don’t know if we were selected purposefully, but my GOD was everyone completely true to their specialty’s stereotype. the ortho dude was a giant ex-football player who spoke in absolutes (with few polysyllabic words in there), the general surgeons were sleek and intense, the psychiatrist next to me got rather drunk, the pathologist was quiet and thoughtful, and the pediatricians (including myself) tended on the overly nice and had trouble getting many words in among the more aggressive folk.

the GME bigwigs were nice although i think the whole event (held at a nice restaurant with flowing red wine) was designed to get us to spill dirty secrets about our work hours. for the uninitiated, there is are a few rules that every residency has to follow, and they are actually laws set by the all-powerful ACGME. the rules are:

1. no more than an average of 80 hours per week averaged over 4 weeks2. 10 hours off between shifts (ie, if you leave at 8 pm, you can’t come back until after 6 am the next day)3. no more than 30 hours in a single shift

now, i think these rules are reasonable, and personally, i STILL manage to practically hallucinate at work and almost hit other cars on the way home at the end of 30 hours in a row. the ACGME bigwigs at the dinner were very supportive of these rules, stating that there is a lot of hard data to prove that we are not safe to practice medicine on patients after a certain level of sleep deprivation. as older physicians, they admitted that they did not train with the rules in place, but that a) it was stupid and dangerous, and b) they made mistakes and c) most of the time, they got a LOT more sleep during the night than we tend to get on call, because the pace of medicine back then just wasn’t the same. we have a much higher burden of sick people nowadays, and we’re doing a lot more for them . . . and yet the number of residents has not risen accordingly.

however, there of course arose arguments from the surgeons that ‘how can we adequately care for our patients when we leave the hospital?’ and ‘when iiiiiii was a 1st year surgery resident, we didn’t have the hours and iiiiiiiii did just fine.’ and my favorite: ‘when i am an attending, there is NO WAY i’m following that rule.’ this came from a married resident with a child. i hope his wife and son are happy and proud that he outright prefers to spend all his time in the hospital. and we wonder why physician divorce rates are high . . .

anyway, i got mad but didn’t say much. i mean, some people survived slavery and the holocaust, too — should we bring back those traditions?? i truly believe that working residents to the ground is unsafe for us as well as for the very patients we are trying to help. i think things are much better now, and i think that 80 hours is a reasonable compromise that allows us to be very immersed in work without complete sacrifice of everything that makes us human. viva la ACGME!

6 Comments

i&#039m with you, sarah – i know what SS used to be like after a 30 hour shift, and he could barely put three words together. if anything, i think those rules should be enforced more strongly than they currently are.